Impact of Conventional Beliefs and Social Stigma on Attitude Towards Access to Mental Health Services in Pakistan

"Gutting It Out" Does Not Work: Why Mental Health Days are Needed

College student mental health issues negatively impact academic performance. Over half of college students in the U.S. report a mental health issue, with 60% reporting one at the two-year mark. Even when aware of such mental health issues, students are still hesitant to seek treatment. As such, investigating perceptions of mental health time off may illuminate perceived usefulness of such policies as well as potential processes for defining and implementing such policies. This study sought to answer the question, "What are the perspectives of time-off for mental health?" Using Reddit's responses, this study extracted (N = 392) quotes and used thematic analysis to identify four main themes. Implications include the need for school-level mental health time-off policies or integration of instructors' policies into their syllabi for transparency to students, which may alleviate student stress and further stigmatization.

Barriers and facilitators to accessing adolescents' mental health services in Karachi: users and providers perspectives

INTRODUCTION

Adolescents' Mental Healthcare (MHC) is influenced by numerous factors, and adolescents occasionally seek professional help for mental health (MH) issues. These factors become more complex within low-middle-income countries (LMICs); therefore, this study aims to understand barriers and facilitators to access mental health services among adolescents aged 10 to 19 years old from the perspective of users (parents) and providers (Mental Healthcare Providers - MHPs).

METHOD

Using a qualitative exploratory design, a semi-structured interview guide was developed using Andersen's health service utilization model. In-depth interviews were conducted with MHPs (n = 21) and parents of adolescents (n = 19) in the psychiatry department of public and private hospitals in Karachi, from October-December 2021. Data was thematically analyzed using an inductive approach.

RESULT

The findings revealed a consensus of users and providers in all three categories of the Andersen model and referred the compulsion as the major driving force to MHC access and utilization rather than personal choices. Within pre-disposing, need, and enabling factors; the participants highlighted a unique perspective; users regarded frequent migration, daily wage loss, and women's societal status as barriers while the need for marriage and patient willingness were stated as facilitators. Whereas, MHPs indicated societal tolerance, the burden on the health system, and the absence of Child and Adolescent Mental Health (CAMH) services as major gaps in service delivery.

CONCLUSION

Service utilization is mainly facilitated by the severity of illness rather than healthy choices and beliefs, and accessibility and affordability. It is therefore imperative to prioritize adolescent MH through promotion and prevention approaches and address service delivery gaps to prevent treatment delays via task-shifting and capacity building of the health workforce.

' Like I said about culture. You don't talk about mental health' : An interpretative phenomenological analysis of the experience of first-episode psychosis in South Asian individuals

BACKGROUND

There is strong evidence of inequalities in mental healthcare access, experiences and outcomes for service users belonging to Black and Asian Minority Ethnic groups experiencing psychosis. Clinicians and academics have speculated that cultural variation in conceptualisations of psychosis, alongside inequitable service provision may explain disparities. There is, however, a dearth of literature exploring this in a South Asian population, despite this ethnic group being the second largest in the United Kingdom. The present study aimed to explore how people from this minority group have experienced and made sense of first-episode psychosis (FEP).

METHODS

A qualitative approach was used to explore the lived experience and sense-making of South Asian individuals experiencing FEP and accessing early intervention services. Eight people were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis.

RESULTS

Three superordinate themes were identified in the group analysis: (1) Disconnection from self and others (2) Doubt and dispute (3) Power and shame.

CONCLUSIONS

Distinctive ethnic, cultural and systemic influences were strongly evident in how people conceptualized their experiences, how they managed their sense-making and where they sought support. Experiences were discussed in the context of power and shame, and this research proposes that socio-cultural context and racialised discourses have an impact on self-concept, the experiences of help-seeking (formal and informal), and fundamentally how services help individuals from marginalized communities.

Community-based mental health and well-being interventions for older adults in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Mental health support is often scarce in low- and middle-income countries (LMIC), with mental health stigmatised. Older adults are some of the most vulnerable members of society and may require specific types of mental health support. The aim of this mixed-methods systematic review and meta-analysis was to explore the types, components, and efficacy of psychosocial community-based mental health interventions for older adults (aged 60 + years) residing in LMIC.

METHODS

Six databases were searched in August 2021. Studies published since 2000 were included if they collected primary quantitative or qualitative data on community-based interventions for improving mental health for older adults residing in LMICs, focusing on improving mental health and well-being outcomes. Full texts were screened by two researchers.

RESULTS

From 24,378 citations identified, 40 studies met eligibility criteria. Across 12 countries, interventions were categorised into those focusing on (1) Established forms of psychological therapy; (2) Exercise; (3) Education; (4) Social engagement; (5) Multi-component. Most interventions were effective in reducing levels of depression, anxiety, and improving well-being, including reminiscence therapy, different types of socialising, and breathing and laughter exercises. Some interventions reported no benefits and those that did at times failed to report continued benefits at follow-up. Given the variations in intervention type and delivery, cultures, and outcome measures used, underpinning factors of intervention success or failure were difficult to establish.

CONCLUSIONS

Psychosocial interventions for older adults in LMIC need to be adapted to local contexts depending on culture and population needs. Existing interventions and their components can be used as a foundation to produce adapted and multi-component interventions, to tackle growing and inadequate mental health care provision in LMIC.

TRIAL REGISTRATION

The review protocol was registered on PROSPERO [CRD42021271404].

Cultural Factors Influencing Mental Health Stigma: Perceptions of Mental Illness (POMI) in Pakistani Emerging Adults

Pakistan has a fast-growing, young, and highly religious population. Mental health literacy and care in Pakistan do not meet the population’s needs, and mental health stigma (MHS) is cited as the cause. Explanations for MHS across cultures include collectivism, and sociocultural-religious/spiritual beliefs and values surrounding mental illness and those who experience it. MHS interventions and campaigns that aim to improve help-seeking behaviors require insight into the emic perspectives of each target population. Although these perspectives have been elusive for Pakistanis, they are more available today due to growing interest in studying and improving Pakistani mental health. This cross-sectional study of 92 Pakistani emerging adults explored whether collectivism was associated with stigmatizing attitudes toward mental illness. This study also piloted the Perceptions of Mental Illness (POMI) questionnaire, a 44-item true/false survey customized to the Pakistani context, to assess how mental health knowledge, perceptions, exposure, and help-seeking preferences related to stigmatizing attitudes. Results indicated that the POMI provided unique insights into Pakistani beliefs and attitudes that relate to both stigmatizing attitudes and collectivism. With further development, the POMI may be used to guide the design of mental health awareness programs in Pakistan, ultimately helping to reduce MHS and increase help seeking when needed.

A Cross-Sectional Survey of Pakistani Muslims Coping with Health Anxiety through Religiosity during the COVID-19 Pandemic

Investigating the role of religiosity in coping with health anxiety during the outbreak of COVID-19 assumes significance given the continued onslaught of the pandemic and the importance of religion in many societies of the world. The aim of this study is to test the relationship between religious coping and health anxiety in Pakistani Muslims. The online survey method was used to collect data from 408 respondents. Structural equational modeling was performed, with results indicating that people who are suffering with health anxiety opt for religious coping (β = .54, R² = .29, p < .001). We conclude that it is important to consider the role of religion and spirituality during pandemic-induced anxiety. There are implications for counselors, physicians and researchers to integrate religious coping methods when planning mental health interventions during pandemics and otherwise.

Clinicians' Perspectives on Self-Harm in Pakistan: A Qualitative Study

Background: Suicide is a serious public health problem, ranked amongst the leading causes of death worldwide. There are no official data on self-harm and suicide in Pakistan; both are illegal acts, and are socially and religiously condemned. This study explored the views of clinicians, including general practitioners (GPs) and hospital physicians (HPs) on self-harm, about their management of people who self-harm and what interventions might be appropriate in Pakistan. Methods: This qualitative study, generating data using semi-structured interviews, was nested within a Randomized Controlled Trial (RCT) of a psychosocial intervention for people following self-harm. Clinicians (n = 18) with experience of treating people who self-harm were recruited from public hospitals and general practices. Results: Face-to-face interviews were conducted in Urdu and digitally recorded with consent, transcribed and translated into English. Transcripts were checked for cultural and interpretive interpretations by the research team, then analyzed thematically using the principles of constant comparison. The following themes will be presented: encountering people with self-harming behaviors; challenges encountered in managing people who self-harm; barriers to accessing care, and what ideal care might look like. Participants identified their lack of training and expertise in the management of people with self-harm behavior. Conclusions: This is the first study to explore clinicians' perspectives on self-harm in Pakistan. The study highlighted the need for training for doctors in the identification and management of mental health problems, including the management of people who self-harm.

A systematic review of mental health literacy in Pakistan

Individual mental health has become a primary global concern. In Pakistan, the prevalence of mental health issues is still unclear, as not many studies have assessed the level of mental health literacy (MHL) in the country. This systematic review aims to bridge this gap by encouraging the early detection of mental disorders, lessening stigma, and improving help-seeking behavior. Nine electronic databases were searched to identify empirical literature in this area. Only studies that evaluated MHL efficacy and those published in English were selected. Non-peer reviewed articles and gray literature were excluded. From 613 studies retrieved, 59 studies met the inclusion criteria and were reviewed. Forty-three of the included studies mentioned mental health outcome measures (of which only four mentioned reliability indices), 13 discussed stigma, 18 examined help-seeking approaches to mental illness treatments, and 47 discussed mental health knowledge. Additionally, the outcome of the MHL measures had considerable heterogeneity and limited validity. Meta-analysis was not conducted due to a lack of MHL operationalization. Besides, the measurement tools in the studies lacked consistency and standardization. This review compiled the available studies on MHL to assist researchers currently studying the various dimensions of MHL, as well as those designing new studies or investigating effective methods to increase MHL. This review highlights the need for well-designed controlled intervention studies. Further implications for researchers, practitioners, and policymakers are mentioned.

COVID-19 pandemic- knowledge, perception, anxiety and depression among frontline doctors of Pakistan

BACKGROUND

COVID-19 is a global pandemic and has become a major public health burden worldwide. With already fragile healthcare systems it can have long lasting effects in developing countries. Outbreaks especially a pandemic situation evokes fear related behaviors among healthcare professionals and there is always an increased risk of mental health disorders. Therefore, this study aims to determine knowledge and perception about this pandemic, prevalence and factors associated with anxiety/depression among frontline physicians of Pakistan.

METHODS

Data were collected through an online survey released in the last week of March-2020. 389 frontline physicians from all four provinces and 65 cities of Pakistan participated. Survey questionnaire consisted of 4 parts including informed consent section, demographic section, knowledge and perception about COVID-19 pandemic and assessment of depression through World Health Organization Self-reporting questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used as cut-off to label the participant as depressed. Data was analyzed using SPSS version22.

RESULTS

A 43% prevalence of anxiety/depression among frontline physicians of Pakistan was reported. Almost all the doctors had moderate to high knowledge score. Majority of participants marked N-95 mask as "essential" during aerosol generating procedures, assessing patients with respiratory symptoms, in COVID patient-care area, ER triage and direct care of COVID-19 patient. Only 12% of the doctors were fully satisfied with the provision of PPEs and almost 94% felt unprotected. In multivariable model, assessing more than five COVID suspects/day (aOR = 2.73, 95% CI: 1.65-4.52), working 20 h/week or less (aOR = 2.11, 1.27-3.49), having children among household members (aOR = 1.58, 95% CI: 1.00-2.50) and moderate to low knowledge of the infection (aOR = 2.69, 95% CI: 1.68-4.31) were found to be independent predictors of anxiety/depression among physicians.

CONCLUSION

Anxiety/depression among more than a third of frontline doctors of Pakistan warrants the need to address mental health of doctors caring for patients during this pandemic; control modifiable factors associated with it and explore the effectiveness of interventions to promote psychological well-being of physicians.